End-of-life care utilization of older adults with heart failure and/or COPD: the role of family availability

BACKGROUND: Heart failure (HF) and chronic obstructive pulmonary disease (COPD), are highly prevalent, thus reducing burdensome end-of-life (EOL) care is critical. Families play a key role at EOL, yet most studies focus on the primary caregiver role. Little is known about the effect of the family network on EOL utilization. OBJECTIVE(S): To examine whether family availability and relationship type are associated with hospitalizations and ED rates in the last six months of life among decedents with HF, COPD, or both. METHODS: Using a Utah population dataset, we conducted a retrospective cohort analysis of 60,142 adults aged ≥55 who died, categorized into three diagnostic groups: HF only(n = 51,222), HF+COPD(n = 8069), and COPD only(n = 851). "Family availability" is defined as having ≥1 first-degree relative residing in Utah at death (n = 210,213). Negative binomial regression models, adjusted for sociodemographic and clinical covariates, estimated associations between diagnosis, family type, and hospitalization and ED rates. RESULTS: Nearly 80 % of decedents had ≥1 hospitalization and 38.9 % had ≥1 ED visit. In adjusted models, diagnosis did not significantly affect utilization. Spouse-only decedents had the highest ED visits (41.8 %; IRR 1.07[1.02-1.12]) and spousal presence was associated with hospitalizations (82.4 %; IRR 1.05[1.02-1.07] and 80.3 %; IRR 1.04[1.02-1.06]) respectively compared to those without family. CONCLUSIONS: Spousal presence was associated with higher ED visits and hospitalization rates among HF and/or COPD decedents. Because linkage indicates geographic presence rather than confirmed caregiving, these findings should be interpreted cautiously. Further research should focus on equipping family members with palliative care skills to optimize EOL care.